IP autism hospital units

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Rapid Growth in US Inpatient Autism Units

January 13, 2012 — Over the last decade, the United States has seen a rapid rise in the number of specialized inpatient psychiatric care units set up exclusively to serve children with developmental disorders, particularly autism, results of a survey suggest.

There are currently 9 of these specialized units in the US; 5 of them opened in the last 10 years. Most are part of tertiary care academic hospital systems, but since 2002, 3 units opened within private, nonacademic institutions; this is a "new phenomenon," researchers say.

The growth in specialized inpatient psychiatry units for children with developmental disorders parallels the growing number of children identified within the last decade with autism, researchers say.

The survey results were published online December 21 in the Journal of Autism and Developmental Disorders.

"Heartening News"

"The genesis of these specialized hospital psychiatry units for children with autism is heartening news," ph Horrigan, MD, assistant vice president and head of medical research for Autism Speaks, told Medscape Medical News.

"These units address a significant unmet medical need that, up until this point, has caused great duress for families and their loved ones with ASD [autism spectrum disorder], especially when severe, disruptive behaviors are present and when there is an uncertain contribution of medical, psychological, social, and educational factors," Dr. Horrigan commented. Autism Speaks did not participate in the survey.

Siegel, MD, medical director, Developmental Disorders Program, Spring Harbor Hospital, Westbrook, Maine, spearheaded the survey. He told Medscape Medical News that the goal of the survey was to describe the system of care in the United States for children with autism and developmental disorder who need psychiatric hospitalization.

"No one has ever done that before," said Dr. Siegel, who runs 1 of the 9 units in the US.

Despite the growth of these programs, currently available beds in these specialized units number only 137, and these are heavily concentrated in the Northeast; none are available west of Denver, Colorado.

The survey shows that children admitted to 1 of these units stay 42.3 days on average and that children with an ASD make up the majority of the inpatient population (62% to 87%).

This may represent a change in the population of these units, because one of the few statistics previously reported (in 1992) identified only 34% of a specialized inpatient psychiatric population as having an ASD, the investigators note in their report.

"In general," Dr. Siegel said, "children and adolescents with autism have been shown to have rates of mental illness that are 3 to 4 times higher than kids in the general population, so it stands that the need for psychiatric hospitalization is going to be significantly greater."

For example, in a study of over 33,000 children enrolled in the northern California Kaiser Permanente health plan, children with an ASD used roughly 12 times as many psychiatric hospital days as children without an ASD and incurred 12 times the cost (Croen et al., Pediatrics, 2006).

In general, children with autism are being hospitalized because of aggressive or self-injurious behaviors or a history of running away. These behaviors are often the result of either a co-occurring mental illness, a severe behavior disorder, or both, Dr. Siegel said.

Consensus on Multidisciplinary Approach

Dr. Siegel said one of the most interesting findings to come out of the survey was that all 9 units, which developed fairly independently of each other, employ multidisciplinary teams with both a child psychiatrist and a behavioral specialist to provide a biobehavioral approach.

This suggests "universal agreement that you have to approach these kids in a multidisciplinary way, which is not the way most general psychiatry units are set up," Dr. Siegel said.

"These inpatient units bring together an array of relevant specialists who are able to provide a rapid and comprehensive assessment of what is going on when individuals with ASD experience severe distress," Dr. Horrigan said.

"These units are also able to implement the initial elements of a hand-tailored, comprehensive, multimodal treatment plan. This is a tremendous value proposition for all stakeholders, the individuals with ASD, their families, and the providers who will assume responsibility for seeing the treatment plan through," he added.

Dr. Siegel said that it is not realistic for all hospitals or states to develop these specialized units.

"Clearly, we can't create enough of them to meet the need. We'd like to develop some protocols to help nonspecialized child units know how to better manage these kids and see if we can show a difference in their treatments and outcomes, because often these kids struggle in nonspecialized units despite everyone's best efforts," Dr. Siegel said.

Unique Research Venue

"I foresee this model of service delivery expanding to all parts of the country," Dr. Horrigan said. "An additional benefit of these specialized inpatient units is they provide a unique venue for intensive types of research that involve serial observation or testing, and this model of research collaborative has the potential to significantly progress our understanding of ASD and its optimal treatments. I applaud the members of this research collaborative for their pioneering work."

Dr. Siegel said "an unanticipated" outcome of the study was the interest in researchers at all 9 units to connect and collaborate with each other.

As a result, "we have formed a national Autism and Developmental Disorders Inpatient Research Collaborative and are looking for funding to support multisite studies," Dr. Siegel said. "It's a great opportunity because we have hundreds of kids moving through these units a year; no recruitment is needed," he noted.

The survey was funded in part by the Pond Family Foundation and a grant from the Main Medical Center Research Institute. The authors and Dr. Horrigan have disclosed no relevant financial relationships.

J Autism Dev Disord. Published online December 22, 2011.

Medscape Medical News © 2012 WebMD, LLC